Addiction Research Foundation Clinical Institute Withdrawal
Assessment Alcohol (CIWA-Ar)
Addiction Research Foundation Clinical Institute Withdrawal
Assessment Alcohol (CIWA-Ar) The scale is not copyrighted and may be used freely.
Patient:
Time:__________________
Date: ___/___/___
y
Pulse or heart rate, taken for one
minute:
m
(24 hour clock, midnight + 0:00)
d
Blood Pressure:
______/______
NAUSEA AND VOMITING  Ask “Do you feel
sick to your stomach? Have you vomited?
Observation.
0 no nausea and no vomiting
1 mild nausea with no vomiting
2
3
4 intermittent nausea with dry heaves
5
6
7 constant nausea, frequent dry heaves and vomiting
TACTILE DISTURBANCES  Ask “Have you any itching,
pins and needles sensations, any burning, any numbness, or do
you feel bugs crawling on or under your skin?” Observation.
0 none
1 mild itching, pins and needles, burning or numbness
2 mild itching, pins and needles, burning or numbness
3 moderate itching, pins and needles, burning or numbness
4 moderately severe hallucinations
5 severe hallucinations
6 extremely severe hallucinations
7 continuous hallucinations
TREMOR  Arms extended and fingers spread
apart.
Observation.
0 no tremor
1 not visible, but can be felt fingertip to fingertip
2
3
4 moderate, with patient’s arms extended
5
6
7 severe, even with arms not extended
AUDITORY DISTURBANCES  Ask “Are you more
aware of sounds around you? Are they harsh? Do they frighten
you? Are you hearing anything that is disturbing to you? Are
you hearing things you know are not there?” Observation.
0 not present
1 very mild harshness or ability to frighten
2 mild harshness or ability to frighten
3 moderate harshness or ability to frighten
4 moderately severe hallucinations
5 severe hallucinations
6 extremely severe hallucinations
7 continuous hallucinations
PAROXYSMAL SWEATS  Observation.
0 no sweat visible
1 barely perceptible sweating, palms moist
2
3
4 beads of sweat obvious on forehead
5
6
7 drenching sweats
VISUAL DISTURBANCES  Ask “Does the light appear to
be too bright? Is the color different? Does it hurt your eyes?
Are you seeing anything that is disturbing to you? Are you
seeing things you know are not there?” Observation.
0 not present
1 very mild sensitivity
2 mild sensitivity
3 moderate sensitivity
4 moderately severe hallucinations
5 severe hallucinations
6 extremely severe hallucinations
7 continuous hallucinations
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Addiction Research Foundation Clinical Institute Withdrawal
Assessment Alcohol (CIWA-Ar) (continued)
ANXIETY  Ask “Do you feel nervous?”
Observation.
1 mildly anxious
2
3
4 moderately anxious, or guarded, so anxiety is
inferred
5
6
7 equivalent to acute panic states as seen in severe
delirium or acute schizophrenic reactions.
AGITATION  Observation.
0 normal activity
1 somewhat more than normal activity
2
3
4 moderately fidgety and restless
5
6
7 paces back and forth during most of the interview,
or constantly thrashes about.
HEADACHE, FULLNESS IN HEAD  Ask “Does your
head feel different? Does it feel like there is a band around
your head?” Do not rate for dizziness or lightheadedness.
Otherwise, rate severity.
0 not present
1 very mild
2 mild
3 moderate
4 moderately severe
5 severe
6 very severe
7 extremely severe
ORIENTATION AND CLOUDING OF SENSORIUM 
Ask “What day is this? Where are you? Who am I?”
0 oriented and can do serial additions
1 cannot do serial additions or is uncertain about date
2 disoriented for date by no more than 2 calendar days
3 disoriented for date by more than 2 calendar days
4 disoriented for place and/or person
Total CIWA-A Score _______
Rater’s Initials
_______
Maximum Possible Score 67
REFERENCE
Sullivan, J. T., Sykora, K., Schneiderman, J., et al. (1989). Assessment of alcohol
withdrawal: the revised Clinical Institute Withdrawal Assessment for Alcohol scale
(CIWA-AR). British Journal of Addiction, 84, 1353-1357.
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